Cotard delusion

Cotard’s delusion, also known as walking corpse syndrome or Cotard’s syndrome.

It is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs.

The denial of self-existence is present in 45% of the cases of Cotard’s syndrome.

 55% of patients present with delusions of immortality.

A mild case is characterized by despair and self-loathing, while a severe case is characterized by intense delusions of negation, and chronic psychiatric depression.

Cotard’s delusion is not mentioned in either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the 10th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) of the World Health Organization.

The main symptom in Cotard’s syndrome is negative delusion, where the patient denies their own existence, the existence of a certain body part, or the existence of a portion of their body. 

Cotard’s syndrome has three stages:

Germination stage: 

Blooming stage:

Chronic stage:

In the germination stage symptoms of psychotic depression and of hypochondria appear.

Full development of the syndrome and delusions of negation occur in the blooming stage.

Chronic stage manifests as continued severe delusions along with chronic psychiatric depression.

Patients neglect their personal hygiene and physical health.

Delusions of negation of self prevent the patient from making sense of external reality.

These individuals have a distorted view of the external world. 

Such delusions of negation are usually found in schizophrenia. 

Causes of Cotard’s syndrome include 

neural misfiring in the fusiform face area, in the fusiform gyrus, and organic lesions in the parietal lobe.

Cotard’s delusion is thought to be related to Capgras delusion, with each type of delusion is thought to result from neural misfiring in the fusiform face area of the brain, which recognizes faces, and in the amygdalae, which associate emotions to a recognized face.

The neural disconnection in Capgras delusion creates in the patient a sense that the face they are observing is not the face of the person to whom it belongs.

Such a face lacks the familiarity normally associated with it, resulting in disconnection from the environment. 

If the observed face is that of a person known to the patient, they experience that face as the face of an impostor 

In Capgras delusion the observed face is that of a person known to the patient, they experience that face as the face of an impostor.

If the patient sees their own face, they might perceive no association between the face and their own sense of self, resulting in the patient believing that they do not exist- the Cotard’s syndrome.

Cotard’s syndrome is usually encountered with psychosis, as in schizophrenia, but is also found in clinical depression, derealization, brain tumor, and migraine headaches.

Cotard’s delusion is associated with lesions in the parietal lobe. 

Cotard’s delusion patients presents with a greater incidence of brain atrophy, especially of the median frontal lobe.

Cotard’s delusion has  been reported with an adverse physiological response to a drug acyclovir) and to its prodrug precursor valaciclovir.


The use of antidepressants, antipsychotics, and mood stabilizer are utilized.

In depressed patients, electroconvulsive therapy (ECT) is more effective than pharmacotherapy.

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